Wang M M, Zhang S S, Liu H, Li Y F, Zhao X H
Department of Radiology, Tongji Hospital Affiliated to Tongji University, Shanghai 200065, China.
Department of Radiology, the Fifth People's Hospital Affiliated to Fudan University, Shanghai 200240, China.
Zhonghua Yi Xue Za Zhi. 2019 Nov 19;99(43):3420-3423. doi: 10.3760/cma.j.issn.0376-2491.2019.43.014.
To explore related factors affecting evolution of recent small subcortical infarct (RSSI) with small-artery occlusion. A total of 96 RSSI patients with RSSI were admitted from Shanghai Tongji Hospital between January 2015 and December 2018. The age of patients containing 60 men was 64.5 (58-73) years, and MRI follow-up time was 11.6 (6.3-11.8) months. Clinical information of patients, images data at baseline head MRI and evolution outcomes at follow-up MRI were collected. All patients were divided into cavitation group (lacunes) and no cavitation group (white matter hyperintensities (WMH) and disappearance) to analyze related factors. Fifty-nine cases (61.5%) developed to cavities, 32 cases (33.3%) were focal WMH, and 5 cases (5.2%) disappeared.In the univariate analysis, RSSI maximum diameter on the DWI or T(2)WI sequence of cavitation group was significantly higher than non-cavitation group, but male proportion was lower (11.6 (9.9-16.6) vs 8.6 (6.9-13.0) mm, 11.8 (9.7-16.2) vs 8.8 (6.7-13.1) mm, 54.2% vs 75.7%, all 0.05). In Logistic regression analysis,the maximum diameter on DWI sequence was an independent predictor of cavity formation (0.022,1.138).When conducting quantitative analysis of infarct diameter and taking infarct maximum diameter ≤10 mm group as reference, the cavitation risk of maximum diameter15 mm group was about 7.5 times higher (0.010, 7.464). The maximum diameter of 10-15 mm lost predictive value for cavity formation (0.129, 2.444). About 61.5% of RSSI develop to cavitation and 38.5% to WMH or disappear. The RSSI showing larger diameter on DWI has a greater possibility of cavitation.
探讨影响近期小动脉闭塞性皮质下小梗死（RSSI）演变的相关因素。2015年1月至2018年12月期间，上海同济大学附属同济医院共收治96例RSSI患者。患者年龄64.5（58 - 73）岁，其中男性60例，MRI随访时间为11.6（6.3 - 11.8）个月。收集患者的临床信息、基线头颅MRI图像数据及随访MRI的演变结果。将所有患者分为空洞形成组（腔隙性梗死）和无空洞形成组（白质高信号（WMH）及消失）以分析相关因素。59例（61.5%）发展为空洞，32例（33.3%）为局灶性WMH，5例（5.2%）消失。单因素分析中，空洞形成组DWI或T(2)WI序列上的RSSI最大直径显著高于无空洞形成组，但男性比例较低（分别为11.6（9.9 - 16.6）mm 对8.6（6.9 - 13.0）mm、11.8（9.7 - 16.2）mm对8.8（6.7 - 13.1）mm、54.2%对75.7%，均P<0.05）。Logistic回归分析中，DWI序列上的最大直径是空洞形成的独立预测因素（P = 0.022，OR = 1.138）。对梗死直径进行定量分析并以梗死最大直径≤10 mm组为参照时，最大直径15 mm组的空洞形成风险约高7.5倍（P = 0.010，OR = 7.464）。10 - 15 mm的最大直径对空洞形成失去预测价值（P = 0.129，OR = 2.444）。约61.5%的RSSI发展为空洞，38.5%发展为WMH或消失。DWI上显示直径较大的RSSI发生空洞的可能性更大。
